1/4. Bilateral occipital neuropathy as a rare complication of positioning for thyroid surgery in a morbidly obese patient.BACKGROUND: Peripheral neuropathies in various locations are described as complications after anesthesia and surgery. This is the first case report of temporary bilateral occipital neuropathy from positioning for thyroid surgery in a morbidly obese patient. methods: A 48-year-old women with a history of depression, fibro-myalgia, asthma, sleep apnea, diabetes mellitus and morbid obesity (127 kg, 165 cm) underwent 4 hours anesthesia with propofol/remifentanil without muscle relaxation for thyroid surgery. The neck with a very low range of motion secondary to fat tissue needed to be extended to facilitate surgery as much as possible. The head was carefully padded and there were no episodes of hypotension or hypoxemia throughout the case or in the PACU. At post op day 1 she complained of bilateral numbness in the distribution area of both greater occipital nerves. On post op day 2 tingling sensations and improvement of numbness was noticed. The patient recovered without residual symptoms after 6 weeks. CONCLUSION: pressure or shear stress to the nerve, hypoperfusion or metabolic disturbances are discussed as the leading etiology of nerve damage during surgery in the literature. pressure from fat tissue during prolonged head extension for surgery seems to be the cause in this case and should therefore be avoided whenever possible in morbidly obese patients, especially when other risk factors for neuropathy like diabetes are present.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/4. Case report: whiplash-associated disorder from a low-velocity bumper car collision: history, evaluation, and surgery.STUDY DESIGN: Case report of a patient with a whiplash-associated disorder following a bumper car collision. Imaging studies failed to provide an anatomic explanation for the debilitating symptoms. OBJECTIVES: To report a chronic, debilitating pain syndrome after a low-velocity bumper car collision while using complex range-of-motion data for the diagnosis, prognosis, and surgical indication in whiplash-associated disorder. SUMMARY OF BACKGROUND DATA: The controversy of whiplash-associated disorder mainly concerns pathophysiology and collision dynamics. Although many investigations attempt to define a universal lesion or determine a threshold of force that may cause permanent injury, no consensus has been reached. methods: Eight years after a low-velocity collision, the patient underwent surgical excision of multiple painful trigger points in the posterior neck. Computerized motion analysis was used for pre- and postoperative evaluations. RESULTS: Surgical treatment resulted in an increase in total active range of motion by 20%, reduced intake of pain medication, doubled the number of work hours, and generally led to a dramatic improvement in quality of life. CONCLUSIONS: This case of whiplash-associated disorder after a low-velocity collision highlights the difficulty in defining threshold of injury in regard to velocity. It also illustrates the value of computerized motion analysis in confirming the diagnosis of whiplash-associated disorder and in the evaluation of prognosis and treatment.- - - - - - - - - - ranking = 4keywords = motion (Clic here for more details about this article) |
3/4. U.S. navy diver/aviator/skydiver with AGE from a previously unknown PFO.A 32 year old US Naval aerospace physiologist with dive, jump and flight qualifications presented to a US Navy hyperbaric medicine department complaining of nausea, unsteadiness and left hand and forearm paresthesia that began almost immediately after completing a 28ft/ 40min recreational dive. Following an abbreviated history and physical examination the patient was diagnosed to be suffering from an arterial gas embolism. He was treated with hyperbaric therapy during which his symptoms resolved. Follow-on transesophageal echocardiography revealed an atrial septal aneurysm with a patent foramen ovale resulting in a right-to-left shunt after valsalva maneuver, but no evidence of ventricular dysfunction, wall motion abnormalities, or abnormal ejection. His episode was attributed to paradoxical air embolism and he was disqualified from further special duty. In order to regain his dive, jump and flight qualifications, the patient elected to undergo repair of the cardiac defect with a device that is relatively new in the operational military setting. The procedure was a success, he was granted waivers for his prior qualifications, and remains in that status to this day. This is the first known case where an atrial septal occluder has been used to preserve these special duty qualifications.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/4. Scopolamine withdrawal syndrome.As travel by air and ship becomes increasingly popular, more and more travelers are using transdermal scopolamine to avoid motion sickness. In fact, it has become almost fashionable for ocean travelers to sit on the sun deck with a patch behind the ear. This article describes withdrawal symptoms in a patient who used transdermal scopolamine beyond the recommended 3 days.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |